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Attitudes to consent--a national survey.

Cleeve S, Curry J

Department of Paediatric Surgery, Great Ormond Street Hospital, WC1N 3JH London, UK.

PURPOSE: The medicolegal case of Chester v Afshar (October 2004) raises important questions with regard to the consent process in medicine and surgery. If consent has to involve disclosure of all serious risks, regardless of frequency, how does a surgeon ensure the thoroughness of the consent procedure and minimise the risk of such litigation? Procedure-specific consent forms (PSCFs)--detailing all serious risks--are a possible solution. The aim of our study was to establish the frequency of the use of such consent forms throughout the UK. METHODS: A postal questionnaire of UK consultant British Association of Pediatric Surgery (BAPS) members was conducted. Members were asked if they used PSCFs for 4 commonly performed procedures in paediatric surgery: central venous access, inguinal herniotomy, orchidopexy, and pyloromyotomy. RESULTS: The response rate was 89% (108/122). We obtained at least one response from every centre involved in paediatric surgery (38/38) in the UK. Seventy-nine percent (85/108) of respondents do not use PSCFs, 19% (21/108) do use PSCFs, and 2% (2/108) forms were returned blank. Thirty-one percent (33/108) of respondents included comments regarding PSCFs. CONCLUSION: A medical negligence claim will succeed if the practitioner owes the patient a duty of care, there has been a breach of this duty, and that the breach caused a loss (causation). Our duty to the patient may now need to include disclosure of all risk regardless of frequency. PSCFs allow accurate and reproducible information for families about procedures. PSCFs currently have a low uptake amongst paediatric surgeons in the UK. The use of PSCFs for 4 procedures is currently under trial in our unit. It remains to be seen whether the success of further claims leads to an increase in their use nationally.

Published 16 February 2006 in J Pediatr Surg, 41(2): 368-71.
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